Obamacare: California far exceeds projections for coverage

By Anna Gorman Kaiser Health News

Posted:
07/30/2014 12:01:00 AM PDT

Updated:
07/30/2014 07:05:31 AM PDT

Allynne Noelle, 32, preps her feet for pointe work at the Los Angeles Ballet studio. The ballerina says spending an average of nine hours a day in pointe shoes can make simple nuisances like corns, ingrown toe nails and blisters quickly become debilitating (Photo by Heidi de Marco/Kaiser Health News).
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Heidi de Marco/Kaiser Health New
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Nearly six of 10 previously uninsured Californians gained medical coverage through the nation's health care law during its first open-enrollment period, according to the most detailed study to date on how the new system is playing out for the state's uninsured.

The percentage -- cited by the Menlo Park-based Kaiser Family Foundation survey -- is much larger than most health care experts had expected.

"If the numbers are accurate and borne out by larger studies, I think it is an indication that the law is working even better than many of us anticipated," said Gerald Kominski, director of the UCLA Center for Health Policy Research, which helped create the official enrollment projections for Covered California, the state's insurance exchange.

Newport Beach restaurant owner Sandra Lopez recently obtained health coverage for her family after years of being uninsured. She plans to look into the Small Employer Health Options Program (SHOP) to see if she can offer health insurance to her staff next year (Photo by Heidi de Marco/KHN).
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All told, 58 percent -- or 3.4 million -- of the nearly 6 million adult Californians who didn't have health insurance before sign-ups began last fall are now covered, the survey said. That's 24 percentage points higher than Kominski's group had estimated.

The largest share of the previously uninsured -- 25 percent -- are enrolled through the state's Medi-Cal program, which has long covered poor families but was expanded this year under the Affordable Care Act (also known as Obamacare) to include adults without children. Nine percent purchased private plans through the insurance marketplace, which opened in October, and 12 percent became insured through their jobs, the researchers found.

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Even though the state exceeded its own expectations for coverage, 42 percent of those previously uninsured still don't have health insurance, according to the survey.

Many said they didn't enroll because of the cost, while some feared that signing up would bring attention to their family's immigration status. Those who are in the U.S. illegally are not eligible for coverage.

The researchers surveyed 2,001 uninsured Californians last summer, then conducted a second round of interviews with many of the same people in the spring. The overall margin of sampling error was plus or minus 4 percentage points.

Sara Rosenbaum, a health law professor at George Washington University, called the study "extremely important."

"Panels where you have the same people that you can go back to over time is absolutely the gold standard in survey research," she said, noting that the state's efforts to reduce the state's uninsured population has national importance.

UCLA's Kominski, however, was troubled by one aspect of the study -- its exclusion of those adults who previously had insurance but lost it for some reason since last summer.

"By not accounting for that, this survey overstates the positive effects of the ACA by as much as 10 percent," he said.

Still, Kominski noted, it's important to "not lose sight of the big picture, which is that even if it's 50 percent, the ACA has had tremendous success in year one in California."

A Commonwealth Fund survey released last month showed that the number of Californians without health insurance has been halved as a result of the Affordable Care Act -- from 22 percent to 11 percent.

The Kaiser survey also revealed that despite an early lag in Latino enrollment, more than half of uninsured Latinos ultimately got coverage. And most newly insured Latinos said shopping for a plan was easy.

Moreover, 58 percent of previously uninsured adults ages 19 to 34 -- the so-called Young Invincibles -- reported getting insurance since last summer, which health care experts see as a good omen for the law.

Before the nation's health law took effect, California had the highest number of uninsured in the nation, coming from highly diverse ethnic backgrounds and cultures. But the state embraced Obamacare before most others and was the first to create a state-run insurance exchange.

The technical problems in California's enrollment process were fewer and less severe than those in the federal exchange and other states. In addition, the hospitals, community clinics and social services offices were aggressive in enrolling those eligible for Medi-Cal, known as Medicaid in other states.

"The fact that a quarter of the previously uninsured Californians ended up enrolled in Medi-Cal points to what a key piece Medicaid is in the puzzle in getting more Americans covered," said Mollyann Brodie, executive director of the Kaiser Family Foundation's Public Opinion and Survey Research.

About 1.4 million people purchased private plans through the insurance exchange, Covered California, by the end of open enrollment -- far more than in any other state.

According to the survey, most of the previously uninsured said their plan is "a good value." But nearly half of people who got plans other than Medi-Cal said that it has been difficult to afford the coverage.

Among the newly insured is Maria Garcia, of East Palo Alto, who sought help from a counselor at the Ravenswood Family Health Center near her home.

Garcia said she didn't feel comfortable navigating Covered California's site and wanted someone to help her. Within hours, the counselor helped her settle on a Kaiser Permanente plan costing just $36 a month thanks to a federal subsidy.

Leslie Ziegler, 31, said signing up for insurance through the Covered California website only took about an hour. Before Obamacare, Ziegler, a San Francisco high-tech entrepreneur, had been turned down by several insurance companies because she had ulcerative colitis, a chronic disease that requires costly medication and treatment.

Companies can no longer deny coverage because of pre-existing conditions. Ziegler is thankful, saying access to insurance and health care whenever she needs it is "a wonderful thing."

Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.